Bone Marrow Transplant (BMT) preparative regimens use high-dose chemotherapy and radiation to destroy cancer cells. Side effects of this life-saving therapy occur when normal cells in the body are also destroyed by the treatment. Cells in the male and female reproductive systems fall into this category, and BMT survivors might suffer temporary or permanent damage affecting future fertility. Little research has been done to provide statistics about fertility after bone marrow transplant, but quality of life issues such as fertility/infertility have been identified as major concerns for cancer survivors.

Recovery after BMT can take months to years, so many patients are not physically or psychologically ready to consider parenthood for several years after transplant. However, a pre-transplant discussion of options to preserve fertility might help you plan for your family's future.

Male fertility issues
You might choose to preserve your fertility before BMT by having your sperm frozen, or banked, for future use in either artificial insemination or in vitro fertilization. If you are interested in sperm banking, please tell your nurse coordinator, who can schedule an appointment in the Andrology Lab. The Andrology Lab will perform an analysis on a fresh semen sample to see if viable sperm are present. If your sperm production is adequate, the Andrology Lab will schedule appointments to collect and freeze your sperm. This will be done before the start of your BMT preparative regimen. If you have already received chemotherapy or radiation therapy, you might or might not still be fertile. Sperm may be frozen indefinitely and annual storage fees are usually charged, which might or might not be covered by medical insurance.

If you do not wish to father children after BMT, the use of contraception is recommended because we cannot predict if or when fertility will return. Several options exist if your infertility is prolonged or permanent and you wish to become a parent once you have recovered from BMT. Alternatives include an assessment by a urologic surgeon who specializes in infertility for possible testicular sperm extraction and use in specialized in vitro fertilization. Other options include the use of donor banked sperm or adoption.

Female fertility issues
Most female patients experience temporary or permanent menopause, also known as premature ovarian failure, as a side effect of bone marrow transplantation. If you have already received chemotherapy or radiation therapy, you might or might not still be fertile. If you are interested in attempting to preserve your fertility after bone marrow transplant, please tell your nurse coordinator, who can schedule an appointment with a gynecologist who is an infertility expert. This is done before the start of your preparative regimen. The gynecologist will use lab tests to assess your current ovarian reserve, review your prior chemotherapy drugs and dosages, and discuss options that might be available to you. Barriers to consider include cost — since insurance companies typically do not cover these treatments — and your age, since fertility decreases as a woman ages.

Unfortunately, our technical ability to preserve ovarian tissue or eggs is still not adequate because ovarian tissue and eggs are much more fragile than a man’s sperm. All of the following options should be considered experimental with an unknown chance of success in producing a viable egg.

Embryo freezing — Mature eggs are stimulated with hormones, removed, fertilized with sperm, and then frozen and stored. This method can require several weeks to accomplish and so might not be feasible for a cancer patient who needs immediate treatment for active disease. Other factors to consider include the availability of a partner to donate sperm, and the ethical decision of what to do with the frozen embryos that might not be used as planned.

Egg freezing — Mature eggs are stimulated, removed, and frozen unfertilized. This method can require several weeks to accomplish, depending on your menstrual cycle, but might be an option for a woman currently without a partner to fertilize the eggs. Live births have been reported with this method, but it is still considered experimental.

Ovarian tissue freezing — Ovarian tissue is removed during an outpatient surgical procedure and frozen for future transplantation back into your body. This method is considered experimental, but the goal is to preserve immature eggs and the tissue that makes female hormones to potentially preserve female fertility.

Medicines — Medicines, such as Lupron— which is a hormone — might be offered during cancer treatment to prevent the cells of the ovary from growing, potentially making them less susceptible to the effects of chemotherapy or radiation. This method is also experimental.

If you do not wish to have children after BMT, the use of contraception is recommended because we cannot predict if or when fertility will return.

If your infertility is prolonged or permanent and you wish to become a parent once you have recovered from BMT, other options exist. These include in vitro fertilization with donor eggs or adopted embryos, surrogacy, or adoption.

Resources
Fertile Hope is a non-profit organization that offers fertility resources for cancer patients. You may visit their Web site at www.fertilehope.org or contact them at 1.888.994.HOPE (4673). Along with information about treatment options, this organization provides excellent suggestions to help overcome some of the financial barriers you might meet.

Your BMT social worker is available for counseling to assist with decision-making.

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